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Comparative Study
. 2025 Feb;135(2):593-601.
doi: 10.1002/lary.31774. Epub 2024 Sep 17.

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis

Mihai A Bentan  1 , Graham Pingree  1   2 , Lawrance Lee  1 , Thomas Fitzpatrick  1 , Theodore Schuman  1
Affiliations
Comparative Study

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis

Mihai A Bentan et al. Laryngoscope. 2025 Feb.

Abstract

Objective: To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).

Methods: The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.

Results: All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%-13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%-19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%-15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%-10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%-7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%-4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%-11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%-22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%-19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%-12.17%, p = 0.005).

Conclusion: Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.

Level of evidence: NA Laryngoscope, 135:593-601, 2025.

Keywords: FESS; allergic fungal sinusitis; chronic rhinosinusitis; endoscopic sinus surgery.

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Figures

Fig. 1
Fig. 1
Risk comparisons in CRSwNP patients for each mAb. The clustered bar graph demonstrates risk percentages of the measured outcomes for each monoclonal antibody compared with its respective control in patients with CRSwNP. Asterisk denotes statistically significant risk percentages. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
Fig. 2
Fig. 2
Risk comparisons in AFRS patients for each mAb. The clustered bar graph demonstrates risk percentages of the measured outcomes for each monoclonal antibody compared with the control in patients with AFRS. Asterisk denotes statistically significant risk percentages. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
See this image and copyright information in PMC

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